Provider Demographics
NPI:1760282727
Name:MANRIQUE, ANGELA L (LAC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:MANRIQUE
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SILVERBEECH CT
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2331
Mailing Address - Country:US
Mailing Address - Phone:862-812-5412
Mailing Address - Fax:
Practice Address - Street 1:999 RIVERVIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1165
Practice Address - Country:US
Practice Address - Phone:551-276-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00816100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor